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January 22, 2018

Childhood vaccination rates are rising—but so are refusal rates, report finds

Daily Briefing

    Vaccination rates among U.S. children enrolled in Blue Cross Blue Shield Association (BCBSA) health plans have risen steadily over the past few years, but vaccine refusal rates among such children also have increased, according to a report released by BCBSA.

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    Report details

    For the report, BCBSA partnered with Blue Health Intelligence and HealthCore to review claims data for more than 840,000 U.S. children enrolled in BCBSA commercial health plans. All children included in the review were born over a four year period, ranging from 2010 through 2013. Researchers reviewed claims data on the children from their birth through three years of age to examine trends in early childhood vaccinations. The report focuses on vaccine completion rates for CDC's recommended seven-vaccine series for children between 2013 and 2016.


    Vaccination rates

    According to the report, 77% of U.S. children with BCBSA commercial health insurance born in 2013 completed their CDC-recommended vaccinations within three years, up from 69% of U.S. children with BCBSA health plans born in 2010 who completed their vaccinations within three years. Overall, completion rates increased by 12%, according to the report.

    Further, the researchers found the individual vaccination rates for each of the CDC's recommended seven-vaccine series reached at least 80% by 2016. However, the researchers found the rates for some vaccines—such as those for diphtheria, measles, and pertussis, and measles—are below the optimum levels recommended by CDC and the World Health Organization to ensure communities have herd immunity. According to the report, the recommended vaccination rate to achieve heard immunity for diphtheria is 86%. The recommended vaccination rate is 94% for measles and pertussis.

    In addition, the researchers found significant variation in vaccination rates by state. For instance, among children with BCBSA commercial insurance born in 2013, the researchers found the 2016 completion rates for CDC's seven-vaccine series ranged from 63% in Nevada to 86% in North Dakota.

    Vaccine refusal rates

    The researchers found that vaccine refusal rates rose by about 70% for U.S. children with BCBSA health plans who were born in 2013 when compared with U.S. children enrolled in BCBSA health plans who were born in 2010. Among U.S. children enrolled in BCBSA health plans, the share with one or more documented vaccine refusal rose from 2.5% among children born in 2010 to 4.2% among children born in 2013.

    According to the report, several factors have led to under-vaccination among U.S. children enrolled in BCBSA plans. For example, the researchers wrote, "Missed well-child visits were identified as the reason for under-vaccination 62% of the time among children completing their vaccinations in 2016." They added, "Among these same under-vaccinated children, documented parental/guardian refusal was identified 6% of the time."


    BCBSA CMO Trent Haywood in a statement said the data "demonstrat[e] that vaccine use among commercially insured people in the [United States] is increasing in the right direction," but "also show large regional variation, indicating there are further improvements to be made." Haywood said the vaccination completion rate "should be closer to the 80% mark, and really, above 90%." He added, "Continued public health efforts can increase childhood vaccination rates by simply touting the benefits of attending regular children's checkups" (Japsen, Forbes, 1/18; Montgomery, ABC15, 1/19; Fox, NBC News, 1/19; BCBSA report, 1/18).

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